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Lancet：不同体重人群的利尿剂降压治疗存在差异

2013-01-06 Lancet CMT 高晓方 编译

氢氯噻嗪贝那普利氨氯地平BMI心血管保护
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　　 　　美国学者的一项研究表明，体重正常和肥胖患者的高血压可能经由不同机制介导。基于噻嗪类的治疗对体重正常患者的心血管保护作用可能逊色于肥胖患者，但基于氨氯地平的治疗则可在不同体质指数（BMI）患者中发挥相同效应。论文于2012年12月5日在线发表于《柳叶刀》（Lancet）。 　　此项研究基于BMI将ACCOMPLISH试验受试人群分为肥胖（BMI ≥30，n=570

　　血压测量

　　美国学者的一项研究表明，体重正常和肥胖患者的高血压可能经由不同机制介导。基于噻嗪类的治疗对体重正常患者的心血管保护作用可能逊色于肥胖患者，但基于氨氯地平的治疗则可在不同体质指数（BMI）患者中发挥相同效应。论文于2012年12月5日在线发表于《柳叶刀》（Lancet）。

　　此项研究基于BMI将ACCOMPLISH试验受试人群分为肥胖（BMI ≥30，n=5709）、超重（25≤BMI<30，n=4157）和体重正常组（BMI<25，n=1616）。ACCOMPLISH受试者已被随机分配给予贝那普利+氢氯噻嗪或贝那普利+氨氯地平治疗。对年龄、性别、糖尿病、既往心血管事件、卒中和慢性肾病进行校正之后，就心血管死亡以及非致命性心梗或卒中主要终点对比事件发生率。采用意向治疗分析。

　　结果显示，在贝那普利+氢氯噻嗪组患者中，体重正常、超重和肥胖患者的主要终点发生率分别为30.7、21.9和18.2/1000患者-年（P=0.0034）。然而，在贝那普利+氨氯地平组患者中各BMI受试者的主要终点无显著差异（P=0.9721）。在肥胖受试者中，贝那普利+氢氯噻嗪和贝那普利+氨氯地平组患者的主要事件发生率基本相似；但在接受贝那普利+氨氯地平治疗的超重（P=0.0369）和体重正常（P=0.0037）患者中主要事件发生率显著降低。

与利尿剂相关的拓展阅读：


Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trial

Background

In previous clinical trials in high-risk hypertensive patients, paradoxically higher cardiovascular event rates have been reported in patients of normal weight compared with obese individuals. As a prespecified analysis of the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial, we aimed to investigate whether the type of hypertension treatment affects patients’ cardiovascular outcomes according to their body size.

Methods

On the basis of body-mass index (BMI), we divided the full ACCOMPLISH cohort into obese (BMI ≥30, n=5709), overweight (≥25 to <30, n=4157), or normal weight (<25, n=1616) categories. The ACCOMPLISH cohort had already been randomised to treatment with single-pill combinations of either benazepril and hydrochlorothiazide or benazepril and amlodipine. We compared event rates (adjusted for age, sex, diabetes, previous cardiovascular events, stroke, or chronic kidney disease) for the primary endpoint of cardiovascular death or non-fatal myocardial infarction or stroke. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00170950.

Findings

In patients allocated benazepril and hydrochlorothiazide, the primary endpoint (per 1000 patient-years) was 30·7 in normal weight, 21·9 in overweight, and 18·2 in obese patients (overall p=0·0034). However, in those allocated benazepril and amlodipine, the primary endpoint did not differ between the three BMI groups (18·2, 16·9, and 16·5, respectively; overall p=0·9721). In obese individuals, primary event rates were similar with both benazepril and hydrochlorothiazide and benazepril and amlodipine, but rates were significantly lower with benazepril and amlodipine in overweight patients (hazard ratio 0·76, 95% CI 0·59—0·94; p=0·0369) and those of normal weight (0·57, 0·39—0·84; p=0·0037).

Interpretation

Hypertension in normal weight and obese patients might be mediated by different mechanisms. Thiazide-based treatment gives less cardiovascular protection in normal weight than obese patients, but amlodipine-based therapy is equally effective across BMI subgroups and thus offers superior cardiovascular protection in non-obese hypertension.

Funding

Novartis Pharmaceuticals.

    

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    2013-03-12 howi

    #Lancet#

    0

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    2013-01-08 huperzia

    #利尿剂#

    0

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    2013-01-08 经常头晕

    #降压#

    0

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    2013-01-08 xugumin

    #降压治疗#

    0

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